Replaced right hepatic artery arising from the distal renal artery, a new variation

Arterial irrigation of the liver is highly variable and widely studied due to its importance in the correct planification of the surgical or endovascular treatment of the hepatobilary area. Various classifications have been published of the common and uncommon anatomic variations of the hepatic arterial distribution. While the classic anatomic pattern of the proper hepatic artery-when it originates from the celiac trunk dividing into left and right branches-represents 50-83% of the described patterns, there are numerous uncommon distributions based on the presence of replaced or accessory hepatic arteries. In this article, we present a case of a replaced right hepatic artery originating from the right distal renal artery.

Contrast enhanced computed tomography (CECT) examination was performed on a 67 years-old male patient with compensated alcoholic cirrhosis as part of the disease monitoring.

The replaced right hepatic artery of the patient arises from the right distal renal artery and-after its cranial course-enters the porta hepatis posterior to the main portal vein. After giving off the cystic artery, it irrigates the right hepatic lobe. The left hepatic artery does not show any variation.

We present CT angiography images of an extremely rare anatomic variation of the hepatic arterial irrigation in a cirrhotic patient.